Dave Ramsey, AARP raise red flag on Medicare | Official Website of Louis Velazquez, entrepreneur, finance guy and tech innovator

With the arrival of the new year and 2025 now in the rearview mirror, many retired Americans are looking carefully at the Medicare plans in which they enrolled during Medicare open enrollment from Oct. 15 to Dec. 7.

Many of them used the Medicare Plan Finder provided by the Centers for Medicare and Medicaid Services that includes information about which doctors and other health care providers are in a Medicare Advantage plan’s network.

The AARP has an important message for those who did.

People who enroll in original Medicare are free to visit any doctor who accepts Medicare — roughly 98 percent of all non‑pediatric physicians, according to KFF, a nonpartisan health policy organization.

Roughly half of all Medicare recipients instead choose Medicare Advantage, a privately administered alternative. These plans restrict members to specific provider networks and often impose higher costs or full charges for care received outside those networks.

For Medicare Advantage members who relied on the plan finder tool during their first three months in a new plan and later learn that the tool listed incorrect provider information — meaning their doctors aren’t actually in‑network — a one‑time special enrollment window in 2026 will allow them to switch to a plan that includes their providers or return to original Medicare.

“So as soon as coverage begins, you should determine whether the providers you want really do take your insurance,” AARP wrote.

Dave Ramsey warns Americans on a Medicare fact

“Medicare is a health insurance program established by the federal government for people 65 and older and folks with certain disabilities,” personal finance author Dave Ramsey explained.

That describes Medicare simply, but there are a lot of details to absorb.

“Why does this dang Medicare feel so confusing?” Ramsey asked. “Well, it was created by the government so that might be your first clue. And second, it’s just a lot to understand.”

Most people rely on employer-sponsored health insurance during their working years because it’s typically the most cost‑effective option, Ramsey clarified.

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After retirement, however, private coverage becomes far more expensive. Medicare was created by the federal government to give retirees an affordable alternative.

Medicare operates as a fee‑for‑service system, meaning you pay a share of the cost each time you receive care — similar to the deductibles and copayments found in standard health insurance plans.

Because it’s a federal program, Medicare negotiates reduced rates with providers who accept Medicare patients. As a result, the Medicare‑approved charges for medical services are generally lower than what you’d encounter with traditional private insurance.

Parts of Medicare explained

These are the parts of Medicare that are important for people to understand, according to Medicare.gov.

Part A (Hospital Insurance)

Pays for inpatient hospital care, stays in skilled nursing facilities, hospice services, and certain types of home health care.
Typically comes with no monthly premium if you or your spouse contributed Medicare payroll taxes for at least 10 years.

Part B (Medical Insurance)

Helps cover physician visits, outpatient treatments, preventive care, medical equipment, and some home health services.
Requires a monthly premium, with the amount adjusted according to your income.

Part C (Medicare Advantage)

Provided through Medicare‑approved private insurers.
Bundles Part A and Part B benefits, often adds prescription drug coverage, and may include extras like dental, hearing, or vision care.
Costs and specific benefits differ from one plan to another.

Part D (Prescription Drug Coverage)

Offers insurance for prescription medications, including many recommended vaccines.
Sold through private plans that partner with Medicare.
Usually involves an additional monthly premium.

Medigap (Supplemental Insurance)

A separate type of private insurance that helps pay out‑of‑pocket expenses—such as deductibles and coinsurance—left over from Original Medicare (Parts A and B).
Plans are standardized and identified by letters ranging from A to N.

Dave Ramsey explains Medicare eligibility

The following are the basic criteria of which Americans must have one for Medicare eligibility, according to Ramsey:

Be 65 years or older
Have a disability status (qualifying for Social Security disability insurance)
Have end-stage renal disease (requiring dialysis or a kidney transplant)
Have amyotrophic lateral sclerosis or ALS (aka Lou Gehrig’s disease)